Experienced Customer Experience and Appeals Specialist with a strong background in processing appeals and grievances, analyzing data, and ensuring compliance with regulatory and accreditation guidelines. Skilled in conducting thorough research, interpreting contract provisions, and providing comprehensive case resolutions. Adept at engaging with customers, gathering necessary information, and delivering timely and accurate responses. Known for attention to detail, data analysis, and ensuring adherence to established practices and standards.
• Processed customer appeals and grievances in compliance with federal, state, and accreditation guidelines.
• Conducted comprehensive research to evaluate and respond to customer cases, ensuring timely and accurate resolution.
• Analyzed and interpreted contract provisions and regulatory requirements to provide appropriate case dispositions.
• Communicated case outcomes to customers, ensuring clarity and empathy while addressing their concerns.
• Collaborated with internal teams to gather necessary documentation and support case resolution.